Hey All-
Etomidate is a good induction drug of choice for RSI, onset is fast and reliable and there are limited side effects, those being some transient adrenocortical suppression and the aformentioned myoclonic activity. There are some other issues such as a higher incidence of nausea and vomiting but it is a great drug and very appropriate for RSI protocols. One of the best things about this particular induction drug is that it causes very mild if any hypotension and usually no decrease in heart rate which can be a real asset since most of the people that need to be intubated cannot usually tolerate any more cardiovascular instability than they are already experiencing.
To respond to the Propofol question, it is a great drug and probably the most commonly used induction agent in the anesthesia world. It is fast in onset, rapidly eliminated and is great for RSI or sedation. The one problem with Propofol is that it can cause some pretty rapid arterial and venous vasodilation along with some mild negative inotropic effects which can lead to a sometimes pretty profound drop in your blood pressure. This drop in blood pressure is usually most profound in those who are hypovolemic to begin with, which is just about any patient that you deal with right? This is probably why Etomidate is a popular choice for many programs. Propofol is a great drug for sedation after the fact and you don't get the hypotension if you are giving sub-induction doses. Don't forget to use your Lidocaine, both these agents can burn on injection.
Hope I helped,
Josh Uecker RN, CRNA, EMT-P
Kansas City, MO
